Cost Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion Five Years After Surgery.

MedLine Citation:

PMID:
22986842
Owner:
NLM
Status:
Publisher

Abstract/OtherAbstract:

ABSTRACT: Study Design. Longitudinal CohortObjective. The purpose of this study is to determine the cost per quality-adjusted life-year (cost/QALY)gained for single-level instrumented Anterior Cervical Discectomy and Fusion (ACDF) over five years.Summary of Background Data. Economic value is an increasingly important component of healthcare policy decision making.Methods. Control ACDF patients with complete five year follow-up data who were part of the Investigational Device Exemption trials for cervical disc arthroplasty were identified. Direct costs for each intervention reported as part of the trial were determined using the 2012 Medicare Fee schedule. Health utility was determined using the Short Form-6D, calculated by transformation from the Short Form -36.Results. There were 352 patients (182 females, 170 males), mean age 44.6 years (22 to 73). Cost per patient for the index ACDF was $15,714. Over five years 41 repeat ACDFs, 15 posterior fusions, 6 foraminotomies, 2 implant removals, 2 hematoma evacuations and 1 esophageal fistula repair were performed. Mean QALY gained in each year of follow-up was 0.16, 0.18, 0.17, 0.18 and 0.18 for a cumulative 0.88 QALY gain over five years. The resultant cost/QALY gained at one year was $104,831; $53,074 at year two; $37,717 at year three; $28,383 at year four; and $23,460 at year five. In this cohort, 11 nerve releases and 26 rotator cuff repairs were done within five years after the index ACDF. Sub analysis to include upper extremity procedures was performed. The cost/QALY gained at one year including upper extremity procedures was $106,256, $54,622 at year two, $38,836 at year three, $29,454 at year four and $24,479 at year five.Conclusion. Increasing health care costs call for demonstration of cost effectiveness in order to justify payment for interventions, including ACDFs. This study indicates that at five year follow-up, single-level instrumented ACDF is both effective and durable resulting in a favorable cost/QALY gained as compared to other widely accepted healthcare interventions.